IV THERAPYPART 2

Catherine Luksic BSN, RN

METHODS OF IV INFUSION

Primary infusion“maintenance infusion”“continuous infusion”

Via gravity Via electronic pump

Secondary infusion“piggyback” “IVPB”

Usually via electronic pump

EQUIPMENT: IV TUBING

Primary IV administration setGravity infusionElectronic pump infusion

Secondary IV administration set“piggyback tubing”

Blood administration Y set Extension tubing Intermittent infusion lock

HL or SL

METHODS OF IV INFUSION Gravity Drip

Manually set, regulated w/ roller clampSimplest methodCount drops manuallyMacrodrip tubing - drop factor determined by

manufacturer Can range from 10-20 gtts/mL (common

10gtts/mL) standard primary tubing for rapid infusions

Microdrip tubing - 60gtts/mL Used for peds, elderly, slower rates

GRAVITY INFUSION

Advantages:EasyDoes not require power source or

pumpCan set-up quickly

Disadvantages:Not greatly accurateNo free-flow preventionRoom for error

CALCULATING A GRAVITY IV RATE

Volume ordered to be infused1000 ml or 1000 cc

Drop factor of tubing being used

Rate of infusion as per order100 ml /hr (or 100 cc/hr)

**refer to IV calculations worksheets

RATE OF IV INFUSION

Check physician orders ! Gravity drip or electronic pump ? cc/hr = ml/hr KVO (10-20 ml/hr) TKO Check IV site & IV rate at least every

hour

PRIMING Refer to procedure Maintain sterility Remember to close the roller clamp 1st

** ?? Invert all Y-sites and tap to remove

air

Demonstration Practice

FACTORS THAT WILL AFFECT FLOW RATE

Height of bag36 inches above heart

Position of roller clamp is it open or closed ?

Patency of tubingCheck for kinks

SLOWED INFUSION RATE Check rate - has it been

changed? Check tubing - is it kinked? Check clamp(s) - are they open? Check site -

is cath or vein being compressed?ANY abnormality? Look for sign of infiltration

ELECTRONIC CONTROL DEVICES

Purpose – improve accuracy of delivery.

Requires power source

Deliver a preset fluid rate over a specified period Uses constant force

Always use pump w/ TPN, central lines, titrated medications, blood products

ELECTRONIC PUMP ALARMS(COMMON)

Occlusion Air-in line Infusion complete Power

ELECTRONIC IV PUMPS

SINGLE CHANNEL

MULTI-CHANNEL

PCA (Patient controlled analgesia)

AMBULATORY IV PUMPS Home care use

NURSING PROCESS

ASSESSMENT

DIAGNOSIS

PLANNING

IMPLEMENTATION

EVALUATION

ASSESSMENT

FIRST STEP, AS ALWAYS chronic conditions use of long-term medications

(anticoagulants) previous IV experiences/problems allergies (especially latex & antimicrobial

agents) hand dominance Skin *Cultural considerations, communication

barriers, level of understanding

ASSESSMENT

Physical examNeurological status – AAO, ability to understand and cooperate

Cardiovascular status – color, pulses, edema, appearance of veins

Skin – bruising, rashes, lesions

NURSING DIAGNOSIS Examples:

Risk for injury related to (lack of knowledge regarding equipment)

Knowledge deficit related to (new IV insertion) AEB (pt verbalization …)

Impaired physical mobility related to placement of peripheral IV AEB…

Anxiety related to (initiation of IV therapy) AEB...

Alteration in comfort: Pain

PLANNING

Patient outcomes and goals - what do you (and the patient!) expect.Ex: Pt. will remain free of S/S of

complications related to IV therapy More specific – Pt. will remain free of

signs of phlebitis

IMPLEMENTATION

Nursing Care:Check site HOURLY for complications - redness, pain,

edema, infiltration Instruct pt. to call nurse immediately: pain, bleeding, other concerns. Instruct pt. to call nurse if pump alarm sounds.Maintain correct infusion rate as ordered.Secure IV (to prevent accidental dislodging of

catheter during movement).Change tubing according to hospital policy (usually q 72 hr.)Change IV site according to hospital policy (usually q 72 hrs.)

IMPLEMENTATION

Nursing Care:2011 Infusion Nurse Society

(recommendations)Do not change IV tubing more frequently

than q 96 hrs.If IVPB tubing is detached from

continuous tubing, change q 24 hrs.

EVALUATION

How will you know if the goal/outcome has been achieved?AssessmentPatient recordLab valuesCommunication